Density of antibiotic use and infectious complications in pediatric allogeneic hematopoietic cell transplantation.

BACKGROUND: Antibiotics, while an essential component of supportive care in allogeneic hematopoietic cell transplantation (allo-HCT), can have adverse effects and select for antibiotic resistance. Understanding of patterns of use will inform antimicrobial stewardship (AMS) interventions. METHODS: Retrospective, single-center cohort of children undergoing first allo-HCT (n = 125). Antibiotic prescription and infection data were included from the date conditioning was commenced until 30 days post allo-HCT. Antibiotic use was reported as length of therapy (LOT) (number of days a patient received an antibiotic) and days of therapy DOT (aggregating all antibiotics prescribed per day). Infections were classified as microbiologically documented infection (MDI) or clinically documented infections. RESULTS: At least one course of antibiotics was administered to 124 (99%) patients. The LOT was 636 per 1000 patient days and DOT was 959 per 1000 patient days. The median duration of cumulative antibiotic exposure per patient was 24 days (interquartile range [IQR] 20-30 days). There were 131 days of fever per 1000 patient days with patients febrile for a median of 4 days (IQR 1-7 days). Piperacillin-tazobactam was used for 116 (94%) of patients with an LOT of 532 per 1000 patient days. A total of 119 MDI episodes occurred in 74 (59%) patients, including blood stream infection in 30 (24%) and a proven/probable invasive fungal infection in 4 (3%). CONCLUSION: Pediatric HCT patients receive prolonged courses of broad-spectrum antibiotics relative to the frequency of fever and bacterial infections. This study has identified opportunities for AMS intervention to improve outcomes for our HCT patients.

Thin-film-transistor digital microfluidics for high value in vitro diagnostics at the point of need.

The latest developments in thin-film-transistor digital-microfluidics (TFT-DMF, also known by the commercial name aQdrop™) are reported, and proof of concept application to molecular diagnostics (e.g. for coronavirus disease, COVID-19) at the point-of-need demonstrated. The TFT-DMF array has 41 thousand independently addressable electrodes that are capable of manipulating large numbers of droplets of any size and shape, along any pathway to perform multiple parallel reactions. Droplets are continually tracked and adjusted through closed-loop feedback enabled by TFT based sensors at each array element. The sample-to-answer molecular in vitro diagnostic (IVD) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) includes nucleic acid extractions from saliva, removal of dsDNA and quantitative reverse transcription polymerase chain reaction (RT-PCR). This proof of concept illustrates how the highly configurable TFT-DMF technology can perform many reactions in parallel and thus support the processing of a range of sample types followed by multiple complex multi-step assays.

Denaturing gradient gel electrophoresis profiles of bacteria from the saliva of twenty four different individuals form clusters that showed no relationship to the yeasts present.

OBJECTIVES: The aim was to investigate the relationship between groups of bacteria identified by cluster analysis of the DGGE fingerprints and the amounts and diversity of yeast present. METHODS: Bacterial and yeast populations in saliva samples from 24 adults were analysed using denaturing gradient gel electrophoresis (DGGE) of the bacteria present and by yeast culture. RESULTS: Eubacterial DGGE banding patterns showed considerable variation between individuals. Seventy one different amplicon bands were detected, the band number per saliva sample ranged from 21 to 39 (mean±SD=29.3±4.9). Cluster and principal component analysis of the bacterial DGGE patterns yielded three major clusters containing 20 of the samples. Seventeen of the 24 (71%) saliva samples were yeast positive with concentrations up to 103cfu/mL. Candida albicans was the predominant species in saliva samples although six other yeast species, including Candida dubliniensis, Candida tropicalis, Candida krusei, Candida guilliermondii, Candida rugosa and Saccharomyces cerevisiae, were identified. The presence, concentration, and species of yeast in samples showed no clear relationship to the bacterial clusters. CONCLUSION: Despite indications of in vitro bacteria-yeast interactions, there was a lack of association between the presence, identity and diversity of yeasts and the bacterial DGGE fingerprint clusters in saliva. This suggests significant ecological individual-specificity of these associations in highly complex in vivo oral biofilm systems under normal oral conditions.

Low-Cost Nanoribbon Sensors for Protein Analysis in Human Serum Using a Miniature Bead-Based Enzyme-Linked Immunosorbent Assay.

We describe a low cost thin-film transistor (TFT) nanoribbon sensor for detection of the inflammatory biomarker C-reactive protein (CRP) in human serum via a miniature bead-based enzyme-linked immunosorbent assay (ELISA). The TFT nanoribbon sensor measures the reaction products from the ELISA via pH changes. The bead-based ELISA decouples the protein functionalization steps from the sensor surface, increasing the signal and simplifying the assay. The ability to directly sense proteins in human serum in this way overcomes the Debye length limitation associated with nanowire and nanoribbon biosensors. Compared to classically fabricated nanowires, the TFT nanoribbon sensors are simple, extremely easy to fabricate, and should therefore be much cheaper to manufacture. TFT nanoribbon sensors, configured to measure pH, were used for quantitative detection of CRP spiked into human serum at concentrations as low as 0.2 ng/mL, which is 10 000 times lower than needed for diagnostic purposes, providing the potential for applications that require very high sensitivity.

Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): Proposed DSM-5 Diagnosis.

Over the past 40 years, a significant body of animal and human research has documented the teratogenic effects of prenatal alcohol exposure (PAE). Neurobehavioral Disorder associated with PAE is proposed as a new clarifying term, intended to encompass the neurodevelopmental and mental health symptoms associated with PAE. Defining this disorder is a necessary step to adequately characterize these symptoms and allow clinical assessment not possible using existing physically-based diagnostic schemes. Without appropriate diagnostic guidelines, affected individuals are frequently misdiagnosed and treated inappropriately (often to their considerable detriment) by mental health, educational, and criminal justice systems. Three core areas of deficits identified from the available research, including neurocognitive, self-regulation, and adaptive functioning impairments, are discussed and information regarding associated features and disorders, prevalence, course, familial patterns, differential diagnosis, and treatment of the proposed disorder are also provided.

Use of denaturing gradient gel electrophoresis for the identification of mixed oral yeasts in human saliva.

A PCR-denaturing gradient gel electrophoresis (DGGE) method was established for the simultaneous presumptive identification of multiple yeast species commonly present in the oral cavity. Published primer sets targeting different regions of the Saccharomyces cerevisiae 26-28S rRNA gene (denoted primer sets N and U) and the 18S rRNA gene (primer set E) were evaluated with ten Candida and four non-Candida yeast species, and twenty Candida albicans isolates. Optimized PCR-DGGE conditions using primer set N were applied to presumptively identify, by band matching, yeasts in the saliva of 25 individuals. Identities were confirmed by DNA sequencing and compared with those using CHROMagar Candida culture. All primer sets yielded detectable DGGE bands for all species tested. Primer set N yielded mainly single bands and could distinguish all species examined, including differentiating Candida dubliniensis from C. albicans. Primer set U was less discriminatory among species but yielded multiple bands that distinguished subspecies groups within C. albicans. Primer set E gave poor yeast discrimination. DGGE analysis identified yeasts in 17 of the 25 saliva samples. Six saliva samples contained two yeast species: three contained C. albicans and three C. dubliniensis. C. dubliniensis was present alone in one saliva sample (total prevalence 16 %). CHROMagar culture detected yeasts in 16 of the yeast-containing saliva samples and did not enable identification of 7 yeast species identified by DGGE. In conclusion, DGGE identification of oral yeast species with primer set N is a relatively fast and reliable method for the simultaneous presumptive identification of mixed yeasts in oral saliva samples.

Avoiding room temperature storage and delayed cryopreservation provide better postthaw potency in hematopoietic progenitor cell grafts.

BACKGROUND: Conditions for maintaining hematopoietic progenitor cells (HPCs) before cryopreservation remain controversial. An understanding of the impact of time and temperature during nonfrozen storage can contribute to the maintenance of the quality of products, improving transplantation outcomes. The objective of this study was to determine the influence on cell potency of thawed products from three sources of HPCs after prolonged storage at different temperatures before cryopreservation. STUDY DESIGN AND METHODS: Viable cell counts by flow cytometry and colony-forming unit (CFU) recoveries were assessed on cord blood (CB), mobilized peripheral blood stem cell (PBSC), and bone marrow (BM) samples over 72 hours using two different storage conditions, refrigerated (4-8°C) or room temperature (19-22°C). To determine the effects of delayed freezing on progenitor recoveries, paired samples were evaluated before and after cryopreservation. RESULTS: All samples maintained at refrigerated temperatures resulted in higher recoveries than those at room temperature in all variables assessed. Specifically, when assessing for CFU yields after thawing, the impact of time on BM resulted in a significant loss as soon as 24 hours (n = 10, 36.4 ± 28.0%, p = 0.003). This decrease was also observed for PBSCs and CB but at 48 hours of fresh storage (PBSCs n = 11, 32.7 ± 26.2%, p = 0.006; CB n = 10, 39.6 ± 26.4%, p = 0.001). CONCLUSION: Our data suggest that HPC products are better maintained at refrigerated temperatures before cryopreservation. Delaying cryopreservation should be minimized to avoid significant losses in cell potency.

In vivo innate immune responses of groper (Polyprion oxygeneios) against Miamiensis avidus infection and lack of protection following dietary vitamin C administration.

Scuticociliates are extracellular histophagous parasites that affect farmed fish worldwide. One of the most common pathogenic species is Miamiensis avidus, a pathogen of New Zealand groper (Polyprion oxygeneios). The aim of this study was to characterise both the host (groper)-parasite (M. avidus) immune interactions and the possible protective role of dietary sodium ascorbate. Head-kidney leucocytes (HKLs) from naturally infected adult groper showed decreased respiratory burst response and peroxidase (Px) levels than healthy individuals. Infected groper also had significantly higher serum Px levels compared to controls. Myeloperoxidase (MPO) was inhibited in the head-kidney (HK) whereas MPO(+) cells were observed in the skin and muscle lesions. The inhibition of the innate immune responses was further studied in experimental infections with M. avidus, which confirmed depletion of Px inside leucocytes and marked increases in serum Px in infected individuals. Groper juveniles were fed a diet supplemented with sodium ascorbate (Vitamin C) (2g Kg(-1)) for 21 days and then challenged by subcutaneous injection or immersion exposure with live M. avidus cells. No protection was observed in the sodium ascorbate fed groper compared to the control diet following challenge by either injection or immersion. In vitro assays showed that sodium ascorbate itself results in the inhibition of Px and respiratory burst of groper HKLs, supporting the results obtained in vivo. Our results show that histophagous protozoa such as M. avidus hamper innate immune defences of fish hosts and that dietary sodium ascorbate does not protect groper against experimental infection with this parasite.

Spatial and temporal variability of the bacterial community in different chemotypes of the New Zealand marine sponge Mycale hentscheli.

Molecular fingerprinting of 16S rRNA genes using terminal restriction fragment length polymorphism (T-RFLP) and denaturing gradient gel electrophoresis (DGGE) was used to characterize the temporal and spatial variability among sponge-associated bacteria from Mycale hentscheli having distinct bioactive chemotypes. Cluster analysis of T-RFLP and DGGE profiles from M. hentscheli chemotypes largely grouped sponge microbial diversity to their distinct chemotype pattern. Repeat sampling of individual M. hentscheli at one location over a 21-month period showed that the T-RFLP profiles from individual sponges had similarity indices ranging from 60% to 82% and calculated DGGE similarities between 23% and 95%. However, a portion (>35% from DGGE and >19% from T-RFLP) of the microbial community from M. hentscheli appeared to be spatially conserved through all M. hentscheli populations. Sequence analysis of DGGE band fragments showed a similarity among the bands originating from different individuals, different times, and different locations. The sponge-associated relationship of these bands was confirmed, with sequences having similarity to sponge-associated bacteria reported from global locations. This study highlights the spatial and temporal complexity in the distribution of bacterial communities associated with different chemotypes of the marine sponge M. hentscheli.

In vitro culture and cryopreservation of Uronema marinum isolated from farmed New Zealand groper (Polyprion oxygeneios).

An in vitro culture method was developed for the ciliated protozoa Uronema marinum isolated from New Zealand aquacultured groper (Polyprion oxygeneios). Both formulated media and sterile seawater supplemented with homogenised fish tissue as a food source supported growth of U. marinum achieving cell densities of up to 1 x 10(5)cells/mL in culture. A cryopreservation method based on a cryomix formula of 20% glycerol, 10% fetal bovine serum and 70% cultured U. marinum, incorporating a slow freeze method to -80 degrees C, then liquid nitrogen storage, allowed cryogenic storage of cells and successful re-culture up to 12 months in storage.

Polyketide assembly lines of uncultivated sponge symbionts from structure-based gene targeting.

There is increasing evidence that uncultivated bacterial symbionts are the true producers of numerous bioactive compounds isolated from marine sponges. The localization and heterologous expression of biosynthetic genes could clarify this issue and provide sustainable supplies for a wide range of pharmaceuticals. However, identification of genes in the usually highly complex symbiont communities remains a challenging task. For polyketides, one of the most important groups of sponge-derived drug candidates, we have developed a general strategy that allows one to rapidly access biosynthetic gene clusters based on chemical moieties. Using this method, we targeted polyketide synthase genes from two different sponge metagenomes. We have obtained from a sponge-bacterial association a complete pathway for the rare and potent antitumor agent psymberin from Psammocinia aff. bulbosa. The data support the symbiont hypothesis and provide insights into natural product evolution in previously inaccessible bacteria.

Surfaces for immobilization of N-terminal cysteine derivatives via native chemical ligation.

This paper presents an improved method for fast, reliable, and quantitative native chemical ligation (NCL--the reaction between an N-terminal cysteine and a thioester to yield an amide bond) at thiophenyl ester-functionalized glass surfaces. For the first time, the degree of surface functionalization has been measured and can be readily controlled by varying the concentration of thiophenyl ester groups on the surface. This methodology facilitates the preparation of tailor-made functionalized glass surfaces for diverse applications. S-Phenyl 11-(chlorodimethylsilyl)-undecanethiolate, and the benzyl analogue, are readily prepared from 10-undecanoic acid via thioester formation and platinum-catalyzed hydrosilylation of the terminal alkene functionality. Thioesters covalently bound to glass surfaces were then formed by submerging clean glass in toluene-solutions of the relevant thioester silylchloride (1%) containing the non-nucleophilic base, ethyldiisopropylamine (1%). NCL was explored with a cysteine-lissamine conjugate, and the degree of surface functionalization was quantified by UV/vis absorption spectroscopy, using the lissamine chromophore. NCL at thiophenyl ester surfaces proved fast (half-life less than 10 min) and yielded levels of surface functionalization consistent with a dense monolayer of dimethyloctylsilane (ca. 2.0 molecules/nm2). Water contact angles on thiophenyl ester surfaces were found to decrease after NCL reaction with the cysteine-lissamine conjugate, whereas surfaces treated with the same buffer solution containing an unreactive alanine-lissamine conjugate showed no significant changes in contact angle, indicating that thioester hydrolysis is not significant during the course of the reaction. NCL with the cysteine-lissamine conjugate at mixed surfaces containing both thiophenyl esters and inert octyl chains showed lower levels of surface functionalization as expected. Plotting the proportion of thiophenyl esters used in the preparation of the substrates against integrated absorption from the surface yielded a linear relationship, demonstrating that NCL on these surfaces occurs in a controllable manner.

Variation in bacterial DGGE patterns from human saliva: over time, between individuals and in corresponding dental plaque microcosms.

OBJECTIVE: Eubacterial 16S rDNA fingerprints of human saliva and dental plaque microcosm biofilms grown in the multi-plaque artificial mouth (MAM) were characterised using denaturing gradient gel electrophoresis (DGGE). DESIGN: The stability of the bacterial community in the saliva of one individual collected over 7 years was assessed and compared with bacterial patterns in the saliva of 10 different individuals. DGGE was also used to assess changes in bacterial composition between saliva and mature plaque microcosms developed in the MAM from these 10 individual saliva samples. RESULTS: A relatively stable bacterial community (>87% concordance) was maintained within the individual oral environment of the standard donor over 7 years of monitoring. By comparison, DGGE fingerprint patterns of saliva from 10 different donors displayed greater variability (66% concordance). Variability between individual DGGE profiles increased further in mature plaque microcosms grown from the saliva of the 10 donors (52% concordance) with an increase in detected species diversity and evidence for conserved similarity and hence the maintenance of organisation during community development. CONCLUSIONS: These results suggest that stable ecological conditions were maintained long-term within the oral environment of the individual saliva donor but that transient fluctuations also occurred. The ecology and predominating microbiota in different individuals was host-specific and these differences were maintained to a degree during development into mature plaque microcosms. These findings also demonstrate the potential usefulness of applying DGGE to monitor temporal and developmental changes and possibly pathogenic patterns in oral bacterial communities from saliva and plaque.

Benzofuran trimers for organic electroluminescence.

Four linear benzofuran trimers have been prepared by a two-stage synthetic procedure. They were tested as materials for organic electroluminescence (OEL). Precursor phenylene ethynylene oligomers were formed in the first stage, then after removal of the phenolic hydroxyl protecting groups, a base was used to promote the cyclization of ortho-hydroxy phenylene ethynylenes to benzofurans. Both acetate esters and tert-butyl carbonates were employed as protecting groups. tert-Butyl and n-hexyl substituents on the benzofurans were used to modulate solubility, aggregation, and film-forming properties; two tert-butyl groups prevented aggregation in the solid state, thus maintaining emission in the blue region of the visible spectrum. The OEL characteristics of the tert-butyl-substituted benzofuran trimer were explored, and blue emission was observed. The two-stage synthetic procedure employed for the preparation of these benzofuran trimers may be applied to a wide variety of benzofuran oligomer and polymer targets.

Carbohydrate-electrolyte feedings and 1 h time trial cycling performance.

The effects of a commercial sports drink on performance in high-intensity cycling was investigated. Nine well-trained subjects were asked to complete a set amount of work as fast as possible (time trial) following 24 h of dietary (subjects were provided with food, energy 57.4+/-2.4 kcal/kg and carbohydrate 9.1+/-0.4 g/kg) and exercise control. During exercise, subjects were provided with 14 mL/kg of either 6% carbohydrate-electrolyte (CHO-E) solution or carbohydrate-free placebo (P). Results showed that subjects' performances did not greatly improve (time, 62:34+/-6:44 min:sec (CHO-E) vs. 62:40+/-5:35 min:sec (P); average power output, 283.0+/-25.0 W (CHO-E) vs. 282.9+/-29.3 W (P), P > 0.05) while consuming the sports drink. It was concluded that CHO-E consumption throughout a 1-h time trial, following a pre-exercise dietary regimen designed to optimize glucose availability, did not improve time or power output to a greater degree than P in well-trained cyclists.

Application of carbon source utilization patterns to measure the metabolic similarity of complex dental plaque biofilm microcosms.

Biolog technology was applied to measure the metabolic similarity of plaque biofilm microcosms, which model the complex properties of dental plaque in vivo. The choice of Biolog plate, incubation time, and incubation conditions strongly influenced utilization profiles. For plaque biofilm microcosms, Biolog GP2 plates incubated anaerobically in an H2-free atmosphere gave the clearest profile. To test the application of the Biolog GP2 assay, plaque microcosms were developed under different nutrient conditions in which the frequency of sucrose application was varied. Cluster analysis of Biolog GP2 data from 10 microcosm biofilms correlated with sucrose frequency. Aciduric bacteria (Streptococcus mutans plus lactobacilli) predominated in the plaques receiving high-frequency sucrose applications. Agreement between the Biolog GP2 groupings with nutrient and compositional changes suggests that Biolog analysis is a valuable technique for analyzing the metabolic similarity of dental plaque biofilm microcosms and other high-nutrient or predominantly anaerobic ecosystems.